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Georgia Center for Oncology Research and Education (Georgia CORE)

FY15 Request for ProposalsGeorgia Access to Care, Treatment and Services (ACTS): Reducing Breast Cancer within Indigent Communities

Release Date: November10, 2014Receipt Date: December 19, 2014Award Date: April 2015

Purpose

The purpose of the Georgia Access to Care, Treatment and Services (ACTS) Grants Program is to expand breast cancer screening, including education, outreach and access, as well as treatment services for the medically indigent consistent with clinical standards-of-care. While Georgia has been successful at increasing breast cancer screening rates, not all women – particularly the medically indigent – receive appropriate screening or treatment services. When identified at an early stage through mammography and clinical breast exams, breast cancer treatment is more effective and mortality rates improve.

In an effort to reduce health disparities for breast cancer in Georgia, the target populations for this grant program are minority, indigent women. For the purposes of this funding opportunity, indigent is defined as individuals who are uninsured, underserved and not eligible for health care public assistance; minority is defined as those racial and ethnic populations that are underrepresented relative to their numbers in the general population.

The State Office of Rural Health, through the Georgia Department of Community Health, has contracted with the Georgia Center for Oncology Research and Education (Georgia CORE) to develop the process for administration, review and evaluation of applications, and disbursement of awards relative to the revenue received from the sale of Breast Cancer License Tags. Because breast cancer affects a great number of Georgians and no cure has been found for the disease, it is appropriate that, subject to the provisions of the official Code of Georgia, the proceeds from the sale of the Breast Cancer License Tag shall be used to support breast cancer-related programs for the medically indigent. These programs are to be provided through the Georgia Access to Care and Treatment Services (ACTS) Grants Program.

All funds will be distributed through a competitive Request for Proposals process that is peer reviewed. This process was designed by Georgia CORE in concert with the Georgia Department of Community Health and the State Office of Rural Health.

1Updated on October 20, 2014

Background

The process to create the Breast Cancer License Tag began in 2001 after Kaiser Permanente physician Dr. Ernie Bodai successfully advocated for the US Postal Service breast cancer research stamp. Kaiser Permanente obtained support from the Atlanta Postmaster to use the image of the breast cancer research stamp designed by Dr. Bodai. Kaiser Permanente then approached the Governor’s office and House of Representatives to request permission to obtain a special license tag for breast cancer. Kaiser Permanente and the Georgia Cancer Coalition worked collaboratively to get the legislation passed in the 2002 Georgia General Assembly.

Article 3 of Chapter 2 of Title 40 of the Official Code of Georgia Annotated, relating to prestige license plates and special plates for certain persons and vehicles was amended by adding a new Code Section 40-2-86.7 (HB 1402 in 2001). Key points are listed below:

“The code states that any motor vehicle owner who is a resident of Georgia upon complying with the motor vehicle laws relating to registration, licensing and payment of a fee of $25.00* in addition to the regular motor vehicle registration fee, shall be issued a Breast Cancer License Tag.”

The funds derived from the sale of the Breast Cancer License Tag (less a $1.00 processing fee) shall be deposited in the Indigent Care Trust Fund to fund cancer-related programs for those persons who are medically indigent and may have breast cancer. Such programs may include education, breast cancer screening, outreach and access, and treatment.

*As of 2011, the initial cost to purchase a Breast Cancer License Tag is $59 in addition to the regular motor vehicle registration fee. The renewal cost is $35. $22 of each purchase or renewal goes into this Indigent Care Trust Fund.

Eligibility

Applications will be considered for either (A) a Treatment Service Project grant award or (B) an Education and Preventive Service Project grant award, in accordance with the standards delineated below for each project type. Entities are not eligible to apply for both Treatment Service Projects and Educational and Preventive Service Projects. Each entity must meet the minimum eligibility requirements for grant funding for the specific project type for which it is applying. Entities with outstanding funding or incomplete progress reports from the previous grant period are not eligible to apply for an additional grant during this funding cycle.

(A)Treatment Service Projects

Provides a process to identify, pre-qualify, and provide treatment services (surgery, chemotherapy, radiation treatment, medications, etc.) to indigent applicants with breast cancer or who have been diagnosed positively with any type of breast pathology. For the purposes of this RFP, biopsies may be considered treatment.

To qualify for consideration for a Treatment Service Project, the applicant must:

Be a 501(c)3 nonprofit organization or public health agency, e.g. a public or private health services entity, a Federally Qualified Health Center (FQHC), a Rural Health Clinic, a Volunteer Clinic, a Rural Hospital or a Critical Access Hospital. Organizations should have a primary care program and any secondary and tertiary care that could be necessary.


Each applicant under the Treatment Service Project must propose to: Carry out projects that facilitate the improvement of health outcomes for breast cancer through treatment for indigent, minority women and other underserved populations in Georgia.

Required Partnerships for Treatment Service Projects: To receive consideration for providing treatment services, the prime organization must already have or must enter into partnership agreements with at minimum, a primary care provider and secondary or tertiary care providers within the targeted region for services. Grantees must be able to describe their methodology for referrals, validation, and verification of need and eligibility in addition to providing follow-up regarding the level of treatment received and the results towards addressing the breast cancer.

(B) Educational and Preventive Service Projects

Includes a targeted communication strategy to educate indigent communities, promote early education, and provide limited mammography screening services and related clinical examinations.

To qualify for consideration for an Educational and Preventive Service Project, the applicant must:

Be a 501(c)3 nonprofit organization or public health agency, e.g. a public or private health services entity, a Federally Qualified Health Center (FQHC), a Rural Health Clinic, a Volunteer Clinic, a Rural Hospital or a Critical Access Hospital. Organizations should have a primary care program and any secondary and tertiary care that could be necessary.

Required Commitments for Educational and Preventive Service Projects: To receive consideration for providing educational and preventive service projects, the organization must develop a targeted strategy to ensure the dissemination of information and screening services reach indigent woman. The organization must have a solid methodology to predict outcomes, delineate a strategy within a monthly project plan, and incorporate key measures to demonstrate success with providing targeted outreach and educational services, especially for indigent women in underserved communities. Education and Prevention projects may partner with Treatment Centers, if the organization elects to do so, but it is not required.

Funds Available

Funding for this project will be utilized to support programs and initiatives in areas of the state where high incidence of disease and health disparities are evident. It is necessary to provide funding in these areas to ensure that the resources are made available to these unique populations that would otherwise not be able to secure such life changing services. Organizations providing education and/or treatment services in Terrell, Appling, Evans, Peach, Jasper and/or Glynn counties will receive greater consideration for funding as these counties have the highest incidence of late stage breast cancer in Georgia.

Providing grant opportunities to communities to address the local needs has been recognized at the state and federal levels as the most cost effective means of managing health care and improving health status. Further, providing primary and preventive care, disease management, and education and wellness programs greatly improves health and is the most cost efficient means of addressing health disparities. Successful grant applications will demonstrate that the funding will increase access to these vital services to enhance the health status of Georgians and improve the economic viability of our communities and state.

Funds generated from the sale and renewal of the Breast Cancer License Tag ($200,000) will be distributed via a competitive Request for Proposals process. Awards of up to $100,000 will be made for Treatment Service Projects and awards of up to $50,000 will be made for Education and Preventive Services Projects. Applicants


can request up to 9.27% in indirect costs. Grants will be paid in two installments: 50% at the time of the award and 50% with the submission and satisfactory review of a 6-month progress report. Closing progress reports (due 10 days after the contract end date) are required.

Organizational Responsibilities

A successful applicant institution is expected to provide matching funds or in-kind support that equals or exceeds the amount of the grant request (>1:1).

Matching funds may be defined as any in cash or in-kind resource relevant and available to the project. The costs of salary and benefits, space and physical facilities, furnishings, supplies, consulting costs, equipment or shared services qualify as matching funds. Grant funding (direct costs), institutional support, and philanthropy are also appropriate sources of matching funds as long as the funds are directly related to the purpose of the award. Indirect cost recovery is not considered as matching support for the ACTS program.

Successful applicants will demonstrate effective collaborative relationships with Georgia CORE’s statewide cancer programs and partners, e.g. Regional Cancer Coalitions of Georgia, Department of Community Health, State Office of Rural Health, Department of Public Health, American Cancer Society, and/or other breast cancer organizations in the state.

Upon acceptance of a grant award, the applicant organization assumes legal and financial responsibility for awarded funds and the conduct of supported activities. It is the responsibility of the organization to assure the appropriateness and quality of clinical services and programs and the accuracy and validity of all fiscal, programmatic and administrative information pertaining to the awarded grant.

Deliverables

Grantee deliverables must be specific to the ACTS program under which the applicant is applying and are developed in accordance with the proposal narrative. For either initiative (treatment or prevention/education) the deliverables include but are not limited to the following:

1. In the grant proposal, provide documentation of the need for (economically and physically), a system of referral that coordinates the required service providers, and specific quantifiable outcomes. Grantees will be measured by both the quantity of service and the quality of service.

2. In the grant proposal, provide evidence of Return on Investment (ROI) through but not limited to a one (1) year strategic plan which evaluates the programs implementation, details the program’s effectiveness, and identifies a plan for sustainability.

3. In the grant proposal, provide documentation of sources of matching funds or in-kind support.

4. During the grant period, provide invoices that include copies of receipts and expense reports, proof of use, and any other documentation in accordance with the grant agreement for payment of services rendered.

5. During the grant period, provide a quarterly statistical report, a six-month progress report, and a closing progress report due 10 days after the contract end date. Templates for all reports will be provided.


Promotion and Acknowledgement of Support

All recipients are requested to promote sales of the Breast Cancer License Tag and distribute information on GeorgiaCancerInfo.org, and required to acknowledge support from Georgia CORE, the Department of Community Health, and the State Office of Rural Health in presentations and publications. Recipients are expected to participate in sponsored/supported meetings and symposia.

Review Process

Georgia CORE will establish an objective review committee including representatives from Georgia CORE, the Regional Cancer Coalitions of Georgia, and partner organizations such as the Department of Community Health, State Office of Rural Health, Department of Public Health and American Cancer Society. Proposals will be reviewed and ranked for completeness, appropriateness and innovation. Georgia CORE staff will be available to provide feedback on results of the review process to unfunded applicants.

Contract Term and Award

The contract term will begin upon execution of the contract and will continue for 12 months unless extended as provided in the contract. It is anticipated that awards will be announced by mid-March 2015.

RFP Amendments/Cancellation

Georgia CORE reserves the right to amend this RFP prior to the date of application submission. Any addenda to the RFP will be posted in the same manner as this RFP.

Submission Process

Complete applications with required attachments must be emailed both as individual MS Word documents and as one single PDF document to [email protected] no later than 5 pm EST on December 19, 2014.

To be considered for funding, the application must be complete with all requested information.

Incomplete, faxed, hand-delivered, mailed, or late applications will not be accepted.

If you have any questions regarding the application or submission process, please contact Georgia CORE:

Monique L. MartinHealth Education and Communications SpecialistPhone: 404-584-5640Email: [email protected]


Georgia Access to Care, Treatment and Services: Reducing Breast Cancer within Indigent CommunitiesFY15 Request for Proposals

ORGANIZATION INFORMATION

Organization Name

Mailing AddressStreet 1:Street 2:City:State:Zip Code:

Phone

Email

Website

Executive DirectorName:Phone:Email:

Proposal Point of ContactName:Title:Phone:Email:

Title of Program

Program Director (Leave blank if this person is the same as the Proposal Point of Contact.)Name:Title:Phone:Email:

Organization Tax Exempt StatusAre you a 501(c)(3) organization?What is your tax ID number?

Organization Financial InformationWhat is your organization’s annual operating budget?What is your program budget?Indicate the year of your most recently filed Form 990:Does your organization conduct an annual audit?


If yes, when was the last audit completed?

Board of Directors Information Form (Please use the attached template.)

NARRATIVE SUMMARY

Title: Provide a short, descriptive title for the program.

Abstract 300 word limit

Provide a brief description of the proposal, including the following: 1) the purpose of the program; 2) who will be served by the program; 3) a description of key activities; 4) a summary of evaluation methods; and 5) concluding remarks regarding the likely impact of the program.

Target Population(s) 300 word limit

Identify and describe the primary target population(s) for the program, including the counties in Georgia served by the program. What is the current magnitude of this problem specific to your local community?

Priority Area

Indicate if the proposal is for a Treatment Service Project or Education and Preventive Service Project.

Will funding support a new or existing program?

Total Dollar Amount Requested

Indicate the total dollar amount of funding requested for this program.

PROGRAM NARRATIVE

Background 600 word limit

Describe the organization’s history, mission, and goals. Describe current programs and recent accomplishments.

Goal(s) and Objectives 400 word limit

State the program goal(s)1 and measureable objectives2. Explain how the goal(s) and objectives address the selected priority area and local needs.

Evidence-based Strategies/Promising Practices 500 word limit

Describe the activities that will be conducted to accomplish the above goal(s) and objectives. Describe how your approach uses or adapts evidence-based strategies3 or promising practices4.Please attach a timeline of activities (required) and logic model (optional) in addition to describing them here.

Evaluation Plan 500 word limit

Describe how you will measure that you are achieving the objectives, how you will assess the impact of the program on the priority area selected, and who will be responsible for evaluation.


Organizational Capacity 500 word limit

Describe the organization’s experience serving the target population(s). Describe the other organizations, if any, participating in the program. Explain why your organization is best-suited to carry out the program.

Sustainability 300 word limit

Explain how this program and its impact will be sustained long-term. What resources (financial, personnel, partnerships, etc.) will be needed to sustain this effort over time? How will those resources be secured?

Budget

Please enter budget numbers using the template provided.

Provide an appropriate budget narrative below. Please provide justification for the items in your budget, detailing how you arrived at that amount. 300 word limit

Describe any sources of current or pending funding for this project, indicating the amount. 100 word limit

Program Management 200 word limit

Who from your organization will be responsible for managing program activities and providing progress reports to Georgia CORE? How is this person uniquely qualified to accomplish this?

ADDITIONAL REQUIRED DOCUMENTATION One Copy of the Organization’s 501(c)(3) Designation Letter One Copy of the Organization’s Most Recent Audit and Form 990 Board of Directors Information Form – use template provided Workplan – use template provided Budget – use template provided Letter(s) of Support – 1 minimum, 3 maximum CV or Resume of Program Director (Two page limit)

ANSWERS TO FREQUENTLY ASKED QUESTIONS

Your non-profit organization must have a 501(c)3 designation. Funding must be used for legal Georgia residents. Biopsies are included in both the education/screening and treatment categories of this funding

opportunity. Georgia CORE will not share any applicant’s audit, 990, Board of Directors list or 501(c)3 designation

letter with reviewers. Georgia CORE must have a copy of these documents in case of an audit.At least 1 letter of support is required; 3 letter of support maximum are permitted..

A goal is a broad-based statement of the ultimate result of the program being undertaken.

2 An objective is a measurable, time-specific and realistic result that the organization expects to accomplish during the grant period. Objectives are specific approaches to achieve the goal.


3 Evidence-based strategies are programs that have been proven to result in a specific outcome, reviewed by peers, and usually published in a public health or medical journal.

4 Promising practices are programs that have proven successful, but for which there may not yet be enough evidence to prove that it has resulted in a positive outcome. They may also be called “emerging best practices.”

Name:_____________________ Date: _____________________

Title: Executive Director/CEOBy typing my name above, I verify that all information submitted is accurate as of the date specified.


Board of Directors Information FormPlease complete the following information for all active board members.

Board Member Name

Board Officer Position

(If none, please leave blank.)

Total Number of

Years on the Board

Employer/Affiliation Gender Race


NAME OF ORGANIZATION Georgia ACTS Work Plan Template

Goal 1:

Objective(s) Activities Time Frame Outcome1.2.

1.2.3.

1.2.3.

1.2.3.

Goal 2:

Objective(s) Activities Time Frame Outcome

Goal 3: Objective(s) Activities Time Frame Outcome



Budget Form

Budget CategoryProject Budget 1:1 Match

6-Month Progress Report

Year-End Report

Personnel Salaries and Wages $0.00 $0.00 $0.00 $0.00 Fringe Benefits $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00 Direct Operating Supplies $0.00 $0.00 $0.00 $0.00 Communication $0.00 $0.00 $0.00 $0.00 Printing & Copying $0.00 $0.00 $0.00 $0.00 Telephone & Fax $0.00 $0.00 $0.00 $0.00 Postage & Delivery $0.00 $0.00 $0.00 $0.00 Travel $0.00 $0.00 $0.00 $0.00 Staff & Board Development $0.00 $0.00 $0.00 $0.00 Local Evaluation $0.00 $0.00 $0.00 $0.00 Program Costs $0.00 $0.00 $0.00 $0.00 Other Expenses $0.00 $0.00 $0.00 $0.00 Other Expenses $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00 Indirect Costs (Administrative overhead or indirect costs up to a maximum of 9.27% of direct costs.)Rent & Utilities $0.00 $0.00 $0.00 $0.00 Project Expenses $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00 Other Costs Equipment $0.00 $0.00 $0.00 $0.00 Consultants $0.00 $0.00 $0.00 $0.00 Professional Fees $0.00 $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00 Total Expenses $0.00 $0.00 $0.00 $0.00

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